65岁以上老年女性宫颈上皮内瘤变治疗方法的探讨

Investigation of treatment for cervical intraepithelial neoplasia in women aged 65 years and over

目的回顾性分析65岁及以上绝经女性宫颈上皮内瘤变（cervical intraepithelialneoplasia，CIN）的临床特点。方法对北京协和医院妇产科2002年7月到2011年12月因CIN收治住院的51例65岁及以上绝经女性的诊治情况进行了总结和分析，并结合相关文献对CIN进行探讨。结果在我院行阴道镜下活检的31例患者中，宫颈鳞柱交界未见为41．9％（13例）。可见宫颈鳞柱交界为58．1％（18例）。其中活检后锥切21例，阴道镜活检诊断低于锥切诊断的为9例。9例中4例（44．4％）发生于宫颈鳞柱交界未见病例，5例（55．6Voo）发生于宫颈鳞柱交界可见病例。51例患者中选择锥切的26例，直接子宫切除的患者20例。14例锥切术后行子宫全切，其中锥切标本为CIN1I～Ⅲ且边缘阴性患者，子宫标本阴性的占100．0％（4／4）；锥切标本为CINII—UI边缘阳性者，子宫标本阴性为50．0％（3／6）。结论65岁及以上绝经女性阴道镜检查中能否看见宫颈鳞柱交界在CIN的诊断中具有重要意义，应尽量行锥切手术；锥切病理提示CINII一Ⅲ，边缘阴性无须再次手术；而边缘阳性患者，如果一般情况不好且有并发症，但随诊条件良好，仍然可以继续监测。如果是宫颈癌则建议行相应全子宫切除或宫颈癌根治术。

Objective To retrospectively analyze the treatment methods ot cervmal intraepithelial neoplasia （CIN） in women aged 65 years and over. Methods From July 2002 to December 2011, 51 postmenopausal women aged 65 years and over with CIN were admitted to our hospital. The diagnosis and treatment were summarized and analyzed, and the CIN related literatures were discussed Results 31 patients received eolposcopy and the colposcopically directed punch biopsy. Squamocolumnar junction （SCJ） was found in 18 patients （58.1% , 18/31）, and not found in 13 patients （41.9% 13/31）. Among the 31 patients, 21 patients received conization after biopsy. 9 patients were under-diagnosed by biopsy, in which 4 cases （44.45） SCJ were found and in 5 cases （55.6 %）SCJ were not found. In all patients, 26 patients received conization and 20 patients received hysterectomy directly. There were 14 patients received hysterectomy after conization. Among 14 patients, the uteruses in 4 patients with conization specimen diagnosed as CIN lI-m and negative margin were 100.0% （4/4）, and the uteruses in 3 patients with eonization specimen diagnosed as CINII-Ⅲ and positive margin were 50.0% （3/6）. Conclusions For women aged 65 years and over, it is very important whether SCJ can be seen or not in colpscopy and directed punch biopsy procedure. It is better to do conization if possible. Patients with eonization specimen diagnosed CINII-[II and negative margin needn＇t subsequent hysterectomy. Patients with positive margin but with bad general conditions or complications can continue to be monitored if they have good follow up conditions. If patients are diagnosed as carcinoma by conization specimen, total hysterectomy or radical hysterectomy is recommended.